PAUL RYAN, MEDICARE RAIDER? — POLITICO’s David Rogers takes a deep dive into the Ryan budget and discovers that the much-touted conservative plan is dependent on a deeper-than-originally-advertised Medicare cut:

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“It gave him the extra margin needed to pay for tax cuts and still placate the right by getting to balance in 2040. But it meant breaking with Ryan’s fellow Medicare reformer, Sen. Ron Wyden (D-Ore.), and raised this question that echoes now in the presidential campaign: Did Ryan cut corners with seniors to pay for tax cuts just as he accuses President Barack Obama of doing to finance health care reform?

“Indeed, calculations by POLITICO — drawn from a Congressional Budget Office analysis commissioned by Ryan in March — show that without the half-point cut, the House Republican budget would still be in the red in 2040. And Ryan’s small adjustment compounds greatly over time: lowering spending for Medicare by hundreds of billions from 2030 to 2040 and well over $1 trillion from 2040 to 2050.” http://politi.co/TD939G

-- AND VOTERS STILL DON'T TRUST ROMNEY ON MEDICARE — As voters get to know Paul Ryan’s Medicare reform plan, they are more trusting of President Barack Obama’s ability to handle the future of the program, according to new polling out today. Fifty-two percent of the public says Obama is the one they “trust to do a better job” in determining Medicare’s future, according to a poll released by the Kaiser Family Foundation. That’s compared with 32 percent who pick Mitt Romney. Obama has made significant gains since July, when the spread in the Kaiser poll was just half that. At that time, 44 percent chose him and 34 percent chose the Republican presidential nominee. And it comes after a series of polls has shown similar results: The public has more trust in Obama to preserve Medicare, and the debate over the program has had a lasting impact on the presidential race.

-- ACA POPULARITY SHOT UP — Kaiser’s poll also recorded a seven-percentage-point jump in popularity for the health reform law. Forty-five percent of respondents reported a favorable view of the law and 40 percent said they had an unfavorable view. It’s the highest favorability rating for the law in two years of monthly polling. Kaiser said the increase was driven by new support from the uninsured and people with lower incomes, as each group recorded at least a 15-percentage-point increase in favorability in September. Both groups stand to gain new benefits under the law. The POLITICO Pro story: http://politico.pro/OWPR4J. The poll: http://bit.ly/SmycTg

Happy Thursday, PULSErs. With polls showing the Republicans Mitt Romney and Paul Ryan trailing — including in Ryan’s home state of Wisconsin and Romney’s deep-blue Massachusetts — PULSE got to wondering, when was the last time a presidential and vice presidential candidate lost both their home states, and how’d that work out? Turns out it was 1972, when Richard Nixon trounced George McGovern and swept every state but Massachusetts. The Huffington Post points out, however, that Romney may want to look for inspiration from Woodrow Wilson and his 1916 running mate Thomas Marshall. They lost their home states of New Jersey and Indiana but went on to win. http://huff.to/PMbpw7

ROMNEY, OBAMA CLASH OVER HEALTH CARE — The candidates posted dueling op-eds Wednesday on the website of the New England Journal of Medicine, featuring few new ideas, some partisan red meat and fleeting glimpses of the broad policies they might pursue over the next four years: http://politico.pro/Qy292c

THE RESULTS OF FAMILY-PLANNING CUTS — Speaking of the New England Journal of Medicine, the publication is out with analysis of what, exactly, happens when states cut their federal family planning funding. The report, using Texas as a model, finds that cutting the programs hampers access to preventive services, results in women being turned away from care and resources pulled from poorer areas.The Pro story: http://politico.pro/Pq0bya

ROMNEY BEAR HUGS ROMNEYCARE -- The Washington Post reports on a feat of political “flexibility” by Romney on health care. Shortly before addressing a Toledo crowd Wednesday and delivering a forceful call for the repeal of the Affordable Care Act, Romney told NBC News that the health law he shepherded through in Massachusetts – which Democrats say laid the groundwork for the ACA – was a model of compassion. “Don’t forget, I got everybody in my state insured. One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record,” Romney said, according to the report. http://wapo.st/S912Tg

--Eddie Vale, spokesman for the pro-ACA Protect Your Care, reacts: “Although he has been all over the place on health care not sure if he's ever gone back and forth this fast!”

-- ROMNEY ON ROMNEYCARE, A PULSE TIMELINE:

- Aug. 8: Romney campaign spokeswoman Andrea Saul invokes Romneycare as a defense against a Democratic charge that Romney caused a laid-off steelworker’s family to lose health coverage. “To that point, if people had been in Massachusetts, under Gov. Romney’s health care plan, they would have had health care,” she said. Conservatives, who despise Romney’s health law, erupted in anger. http://politi.co/QfjhFg

-Later that day, Romney alluded to his health law: “We’ve got to do some reforms in health care, and I have some experience doing that as you know, and I know how to make a better setting than the one we have in health care,” he said, according to The Washington Post: http://wapo.st/MPHoel

- Aug. 23: On MSNBC’s Daily Rundown, Romney described himself as “very proud” of the Massachusetts health law. “It certainly was an important accomplishment to get Republicans and Democrats to find common ground and to solve a problem for our state in a way that was creative and I think is working, by and large, pretty well,” he said. http://bit.ly/Oyz0Bv

- Aug. 26: On “Fox News Sunday,” Romney said: “I’m the guy who was able to get all the health care for all the women and men for my state … We actually did something and we did it without cutting Medicare and without raising taxes.” http://politi.co/OfDxIT

- Aug. 30: Romney makes no mention of Romneycare during his primetime address at the Republican National Convention. http://politico.pro/OwF1yq

- Sept. 26: “Don’t forget, I got everybody in my state insured. One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.” http://wapo.st/S912Tg

SOUTH DAKOTA TO LET FEDS HANDLE EXCHANGE — That’s what Gov. Dennis Daugaard, a Republican, announced Wednesday, citing “extensive research and analysis” that suggested a state-run exchange would “simply not work,” according to the Yankton Daily Press & Dakotan. Daugaard said the exchange would cost $6.3 million to $7.7 million per year. “The federal law requires exchanges to be self-sustaining by 2015, which means we would either have to charge a fee to South Dakota citizens using the exchange, or increase taxes, neither of which I am willing to do,” Daugaard said. http://bit.ly/QVKrmW

POLITICO PRO DEEP DIVE — Join members of the Pro health care team at 8 a.m. on Monday for an in-depth look at the future and policies of the FDA. Special guests include Jeff Allen of Friends of Cancer Research, Allan Coukell of The Pew Charitable Trusts, Janet Woodcock of the FDA and Sara Radcliffe of Biotechnology Industry Organization. RSVP to http://bit.ly/Upbtq9.

INTRODUCING POLITICO PRO FINANCE — Starting today, Pro readers will get the latest news on the intersection of Washington and Wall Street via breaking news alerts, quick Whiteboard items and in-depth journalism — plus invitations to Pro-only events. Pro Financial Services readers will get an enhanced version of Morning Money every weekday by 6 a.m. (Non-Pros will get the current version of Morning Money at 8 a.m.) Pro Tax readers will receive an exclusive newsletter intensely focused on tax policy. To learn more, contact Pro Services at (703) 341-4600 or info@politicopro.com.

WHAT WE’RE READING, by Joanne Kenen

Forbes says Aon Hewitt will have a new corporate exchange and more than 100,000 workers at mid-sized U.S. businesses will sign up for their health plan on it this fall. Nine national and regional carriers will participate. The post: http://onforb.es/NSoAyM

The Wall Street Journal reports that Sears and Darden Restaurants are shifting how they provide employee health benefits to a defined benefit, with a choice of plans on an online market. This could be a sign of a swing similar to that employers made when they moved away from pensions to 401 (k) contributions. The article: http://on.wsj.com/SmRzao

A JAMA essay looks at why diagnostic errors are so common, so crucial — and yet largely ignored in quality improvement and pay for performance programs. The essay: http://bit.ly/S9g8Ig

NPR Shots blog report on a program developed by Sen. John Kerry’s physician daughter Dr. Vanessa Kerry to partner with the Peace Corps to send doctors and nurses abroad. The post: http://n.pr/QnNSVR

The NYT publishes a batch of letters to the editor about the recent articles on health IT and bill “upcoding” Some blame fee for service, others wonder where the patients are in this discussion. The letters: http://nyti.ms/SC1D5c

A Health Affairs Web first article says dedicated short-stay observation units in hospitals could save $3.1 billoin a year. The study focused on short stays — not longer stays that could end up shifting costs to patients or making it harder for them to get Medicare-covered rehab. http://bit.ly/S0JdLG

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** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Kyle Cheney is a reporter for POLITICO’s Campaign Pro.

Cheney came to POLITICO in June 2012 to cover health care and spent two years covering the implementation of the Affordable Care Act and its political implications – from the Supreme Court decision upholding the law to the rollout of HealthCare.gov and the coverage gains that ensued. He came to POLITICO after five years reporting on Massachusetts government and politics for the State House News Service, an independent wire service. Coverage, which appeared daily in The Boston Globe, Boston Herald and others, included the implementation of a near-universal health care law; the indictment, trial and conviction of the state’s third felonious House speaker in a row; the rise and reelection of Gov. Deval Patrick; and all matters of public policy.

Cheney, a New York native and unabashed Yankees fan, graduated from Boston University in 2007 with a journalism degree after a semester as editor of BU’s student paper, The Daily Free Press.